Description (Taken directly from the application): This project is one of three to be conducted by the Outcomes Evaluation Core within the D&E Division. It is a continuation of the D&E Project 4 of the current grant cycle (1992-97), entitled "Public Health Demonstration Project." The new name, "Proactive Prevention in Diabetes Care: The Underinsured," and a companion project (entitled "Proactive Prevention in Diabetes Care: In Managed Care") reflect the evolution of the concept of proactive prevention in diabetes care from a primarily public health to a broader application to all of diabetes care wherever and however delivered. Both projects seek to provide convincing evidence that the inclusion of a proactive prevention program in the care of diabetic patients in the precomplication phase of their illness will significantly improve the health of these patients and be cost-effective in the long run. This intention is Aim 1 for this project, Years 1-3. In pursuit of Specific Aim 1, 150 patients will be recruited from the Jackson, Michigan area (economically depressed, many uninsured) and randomly assigned to an experimental and control arm. All patients will have an extensive assessment of all aspects of their diabetes status at baseline and 18 months later. The patients in the experimental arm (approximately 75) will receive an individualized, intensive and proactive set of interventions designed to correct important problems (metabolic status, blood pressure, hyperlipidemia, microalbuminuria, smoking) for which effective modification strategies exist that will delay or ameliorate costly diabetes complications. Collective improvements in these parameters in the experimental versus the control arms during the 18-month intervention period will be compared with the experience of the preceding public health project for a combined analysis of the cost effectiveness of the addition of an aggressive, proactive prevention program to diabetes care in this country. Specific Aim 2 proposes to develop, implement and evaluate a training program for health professionals, primarily nurses, to provide the key element in programs offering proactive prevention in diabetes care, Years 3-5. Specific Aim 3 will extend the concept of proactive prevention in diabetes care to the Diabetes Outreach Networks of the Michigan Diabetes Control Program that now cover the entire state of Michigan, Years 3-5.